CORRECTION OF PARASTOMAL HERNIA USING THE PAULI TECHNIQUE

Male, 53 years old, with a history of abdominoperineal amputation due to rectal adenocarcinoma in 2017, presents oncological cure criteria. He developed a difficult-to-treat parastomal hernia, having undergone two surgeries with on-lay mesh placement, both of which resulted in recurrence. Clinically, he exhibited bulging and discomfort in the hernia location, and the CT scan showed a large parastomal hernia. In April 2024, he underwent another approach to the parastomal hernia using the Pauli technique, which was first described in 2016. The patient had a good recovery, wore an abdominal belt for two months, and maintained an appropriate weight control. To date, he shows no signs of recurrence. Parastomal hernia is the most common complication after creating a stoma and can lead to significant morbidity, affecting quality of life. Its incidence is higher in terminal colostomies, and the use of prophylactic synthetic mesh is recommended by the European Hernia Society. Several surgical techniques have been described, but recurrence rates remain high, even with mesh use, ranging from 6.9% to 17%. Simple suture repair of the aponeurosis has recurrence rates of around 46%. The Pauli technique is a modification of the Sugarbaker technique, in which the stoma is left in place. A median incision is made, followed by an incision in the posterior sheath of the abdominal rectus, lateral retro-muscular dissection past the semilunar line to free the transverse abdominal muscle, and then closure of the hernia defect in the posterior aponeurosis of the abdominal rectus or the transversalis fascia (below Douglas' arcuate line), laterally shifting the stoma. The mesh is placed in a sublay position, supporting the intestine without an opening in the mesh, similar to the Sugarbaker technique. Dissection may be performed similarly on the opposite side, so that the mesh overlaps and corrects any defects in the midline. This technique offers clear advantages, such as maintaining the biomechanical function of the abdominal wall, the ability to repair hernias in the midline, keeping the stoma in the same location to avoid complications in the closure area or a new parastomal hernia in a new site. The authors recommend this technique for large hernias, recurrent cases, or when the minimally invasive Sugarbaker technique is not feasible.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025